系統性免疫發炎指數SII可作為上泌尿道上皮癌的預後因子
詹皓程、楊文宏、歐建慧
成功大學附設醫院 泌尿部
Systemic immune-inflammation index (SII) is a useful prognostic indicator for patients with upper tract urothelial carcinoma
Hau-Chern Jan1, Wen-Horng Yang1, Chien-Hui Ou1.
1. Department of Urology, National Cheng-Kung University Hospital, Tainan, Taiwan.
Introduction
Upper tract urothelial carcinoma (UTUC) is a rare malignancy in urinary system. In order to improve preoperative treatment choice and management of postoperative surveillance, identification of prognostic factors is necessarily required. To our knowledge, the elevation of systemic inflammatory markers may imply the development of an inflammation-associated microenvironment in tumors. The aim of this study is to identify a novel prognosticator, systemic immune-inflammation index (SII, neutrophil x platelet / lymphocyte), in patients with UTUC undergoing radical nephroureterectomy (RNU).
Material and Methods
The records of 424 patients who underwent RNU at National Cheng-Kung University Hospital, Taiwan from 2007 to 2017 were analyzed. The neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), MLR, and SII for each patient were calculated and their optimal cut-off values are identified by a receiver operating characteristic curve. Sub-classification based on optimal cut-off values of biomarkers was performed. Kaplan–Meier analyses and Cox proportional hazards models evaluate associations with overall survival (OS) and cancer-specific survival (CSS).
Results and Discussions
The median follow-up duration is 35 [interquartile range:14-60] months (Mean:40 months). Receiver operating characteristic curve is applied to identify the optimal cutoff point with the highest sensitivity and specificity, which was 4 for NLR, 150 for PLR, 0.4 for MLR, and 580 for SII. The AUC for SII was 0.701, which was better than NLR, PLR and MLR for predicting survival, which indicated SII was superior to NLR, PLR or MLR as a predictive factor in UTUC patients. Further Kaplan–Meier analysis showed that high level NLR, PLR, SII, and MLR was significantly associated with poor OS and CSS (all, P < 0.05). In multivariable analysis, MLR remained the significant association with OS (P=0.014) and SII significantly influenced on both OS and CSS (P=0.030 and P=0.008, respectively).
Conclusion
Our retrospective study underlines the importance of the first discovering SII to significantly predict outcomes in patients with UTUC. SII is superior to NLR, PLR, and MLR for predicting survival. Furthermore, SII may serve as an independently prognostic factor in UTUC patients.